Extracranial Carotid Stenosis: Drug Therapy

Therapeutic target

• Prevention of apoplexy (stroke).

Therapy recommendations

• Platelet aggregation inhibition, if appropriate; take note:
  • In >50% asymptomatic arteriosclerotic carotid stenosis (narrowing of the vessels supplying the brain):
    • Acetylsalicylic acid (ASA) and statins (cholesterol-lowering drugs).
    • In men, the risk of myocardial infarction (heart attack) and apoplexy (stroke) is reduced by antiplatelet drugs.
  • In symptomatic carotid stenosis, long-term monotherapy with an antiplatelet agent is recommended (ESC Guidelines: Class I)
  • After carotid stenting (“vascular bridge in the carotid artery“), dual antiplatelet therapy with ASA and clopidogrel is recommended for at least 1 month (ESC Guidelines: Class I), followed by long-term monotherapy.
  • If oral anticoagulation (OAC) is indicated, it should be given alone (ESC Guidelines: IIa).
• In addition to patients receiving conservative therapy, all patients undergoing surgical therapy should also receive ASA.
• See also under “Surgical therapy” and “Other therapy”.